IQ-Connect™

Problem: There are no affordable available data sources on dynamic geographic accessibility to essential health services offering equity perspectives for cities. Therefore, the planning of land use, urban development, or health services seldom considers accessibility.[1–8]

Few studies look at dynamic accessibility to health services. These studies use sophisticated methods and metrics that are presented with a complexity that policymakers and stakeholders might not understand, limiting their ability to share findings directly with their peers and constituencies. These complex approaches might also miss critical policy points and the perspectives provided by end users.[9]

Without a practical approach to monitoring the links between accessibility, traffic congestion, and health equity, this critical perspective will continue to be absent from urban and health services planning, missing opportunities to improve accessibility through intersectoral action and stakeholder engagement.

Our assessments show that services are concentrated far from where many users need them. Locations seem to be more convenient to service providers than to end users. Our work reveals this and shows that this might be especially affecting populations facing vulnerability, taxing them with long journeys and high costs.

This is a global issue affecting cities around the world, but especially in Low-and Middle-Income Countries (LMICs), where inequalities in access to primary health services are more profound and where resources to assess accessibility are more limited.

As part of Luis Gabriel Cuervo's doctoral thesis, a pilot study, called the Amore Platform, was built to assess and propose a solution to the issues described above. Based on this pilot, IQuartil is developing a commercial version of the solution named IQ-Connect, that is afordable and delivers dynamic data on accessibility to essential health services with an equity perspective.[10–14]  

In the pilot study done for Cali, Colombia, a city of about 2.3 million inhabitants, more than half the population has limited accessibility to primary health services, in terms of travel times and costs, at hours of high traffic congestion.[18] 

To summarize, the key aspects of the problem are:

• The paucity of data on dynamic accessibility to health services means that poor accessibility among some populations is hiding in plain sight, perpetuating social injustice.[1]
• Accessibility assessments for health services mostly use static estimates of average travel time or distance that miss the variations caused by traffic congestion.[1-4]
• Traditional studies use distance and average travel times as indicators of accessibility; time-to-destination should be used in cities where traffic congestion compromises the validity of static assessments.[1]
• Dynamic accessibility assessments frequently lack equity perspectives; accessibility and the effects of traffic congestion likely vary among city dwellers and sectors and as the city changes.[1,19] 
• Specialized homogeneous research groups mostly lack inputs from stakeholders and data consumers; the lack of engagement of relevant sectors and groups limits the implementation of findings.[13,15,16]
• The use of sophisticated specialized approaches, statistics, and metrics are barriers for relevant groups and sectors to use concepts and findings, let alone communicate them to their peers and constituencies.[9]
• Studies assessing accessibility to health services frequently focus on institutions; if not all institutions offer these services, the results will lack specificity and be misleading.
• Traditionally used, accessibility assessments use sampling to make inferences and are onerous and tardy. Circumstances may have changed when results are published, and updating them is usually not an option.[1]

Dynamic data on accessibility is needed to develop, enhance, and report indicators relevant to the Sustainable Development Goals and Primary Health Care.[17]

SUPPORTING REFERENCES

1. Cuervo LG, Martínez-Herrera E, Cuervo D, Jaramillo C. Improving equity using dynamic geographic accessibility data for urban health services planning. Gac Sanit [Internet]. [cited 2022 Jun 11];(ePublication ahead of print). Available from: http://www.gacetasanitaria.org...

2. García-Albertos P, Picornell M, Salas-Olmedo MH, Gutiérrez J. Exploring the potential of mobile phone records and online route planners for dynamic accessibility analysis. Transp Res Part Policy Pract [Internet]. 2019 Jul [cited 2021 Nov 14];125:294–307. Available from: https://linkinghub.elsevier.co...

3. Moya-Gómez B, Salas-Olmedo MH, García-Palomares J, Gutiérrez J. Dynamic Accessibility using Big Data: The Role of the Changing Conditions of Network Congestion and Destination Attractiveness. Netw Spat Econ. 2018 Jun 1;18.

4. Bimpou K, Ferguson NS. Dynamic accessibility: Incorporating day-to-day travel time reliability into accessibility measurement. J Transp Geogr [Internet]. 2020 Dec 1 [cited 2022 Apr 21];89:102892. Available from: https://www-sciencedirect-com.ezproxyberklee.flo.org/...

5. Carrasco-Escobar G, Manrique E, Tello-Lizarraga K, Miranda JJ. Travel Time to Health Facilities as a Marker of Geographical Accessibility Across Heterogeneous Land Coverage in Peru. Front Public Health [Internet]. 2020 [cited 2022 Apr 21];8. Available from: https://www.frontiersin.org/ar...

6. Ma L, Luo N, Wan T, Hu C, Peng M. An Improved Healthcare Accessibility Measure Considering the Temporal Dimension and Population Demand of Different Ages. Int J Environ Res Public Health [Internet]. 2018 Nov [cited 2020 May 7];15(11). Available from: https://www.ncbi.nlm.nih.gov/p...

7. Neutens T. Accessibility, equity and health care: review and research directions for transport geographers. J Transp Geogr [Internet]. 2015 Feb 1 [cited 2022 Jan 20];43:14–27. Available from: https://www-sciencedirect-com.ezproxyberklee.flo.org/...

8. Jin T, Cheng L, Wang K, Cao J, Huang H, Witlox F. Examining equity in accessibility to multi-tier healthcare services across different income households using estimated travel time. Transp Policy [Internet]. 2022 Jun 1 [cited 2022 Apr 7];121:1–13. Available from: https://www-sciencedirect-com.ezproxyberklee.flo.org/...

9. Whitty CJM. What makes an academic paper useful for health policy? BMC Med [Internet]. 2015 Dec 17 [cited 2022 Mar 24];13(1):301. Available from: https://doi-org.ezproxyberklee.flo.org/10.1186/s12916...

10. Abookire S, Plover C, Frasso R, Ku B. Health Design Thinking: An Innovative Approach in Public Health to Defining Problems and Finding Solutions. Front Public Health [Internet]. 2020 [cited 2022 Jul 18];8. Available from: https://www.frontiersin.org/ar...

11. Brown T, Wyatt J. Design Thinking for Social Innovation. Dev Outreach [Internet]. 2012 Oct 3 [cited 2021 Apr 2]; Available from: https://elibrary.worldbank.org...

12. Hendricks S, Conrad N, Douglas TS, Mutsvangwa T. A modified stakeholder participation assessment framework for design thinking in health innovation. Healthcare [Internet]. 2018 Sep 1 [cited 2021 Apr 2];6(3):191–6. Available from: https://www-sciencedirect-com.ezproxyberklee.flo.org/...

13. Papa E, Coppola P, Angiello G, Carpentieri G. The learning process of accessibility instrument developers: Testing the tools in planning practice. Transp Res Part Policy Pract [Internet]. 2017 Oct [cited 2021 Jan 23];104:108–20. Available from: https://linkinghub.elsevier.co...

14. Cuervo LG, Jaramillo C, Cuervo D, Martínez Herrera E, Hatcher-Roberts J, Pinilla LF, et al. Dynamic Geographical Accessibility Assessments to Improve Health Equity: Protocol for a Test Case in Cali, Colombia [Evaluaciones Dinámicas De Accesibilidad Geográfica Para Mejorar La Equidad: Prueba En Cali, Colombia: Protocolo De Investigación] [Internet]. Rochester, NY; 2022 [cited 2022 Jul 29]. Available from: https://papers.ssrn.com/abstra...

15. Jull J, Giles A, Graham ID. Community-based participatory research and integrated knowledge translation: advancing the co-creation of knowledge. Implement Sci [Internet]. 2017 Dec 19 [cited 2021 Mar 25];12(1):150. Available from: https://doi-org.ezproxyberklee.flo.org/10.1186/s13012...

16. Government of Canada CI of HR. Guide to Knowledge Translation Planning at CIHR: Integrated and End-of-Grant Approaches - CIHR [Internet]. 2012 [cited 2021 Mar 25]. Available from: https://cihr-irsc.gc.ca/e/4532...

17. B. Giles-Corti et al., “What next? Expanding our view of city planning and global health, and implementing and monitoring evidence-informed policy,” Lancet Glob. Health, vol. 10, no. 6, pp. e919–e926, Jun. 2022, doi: 10.1016/S2214-109X(22)00066-3.

18. Cuervo, LG, Martínez-Herrera E, Osorio L, Hatcher-Roberts J, Cuervo D, Bula MO, Pinilla LF, Piquero F, and Jaramillo D. “Dynamic Accessibility by Car to Tertiary Care Emergency Services in Cali, Colombia, in 2020: Cross-Sectional Equity Analyses Using Travel-Time Big Data from a Google API.” BMJ Open (in press) (n.d.). http://dx.doi.org.ezproxyberklee.flo.org/10.1136/bmjopen-2022-062178.

19. Hernández, D and Rossel C. “Unraveling Social Inequalities in Urban Health Care Accessibility in Montevideo: A Space-Time Approach.” Journal of Urban Affairs, April 28, 2022, 1–16. https://doi-org.ezproxyberklee.flo.org/10.1080/07352166.2022.2044838.

Solution: IQ-Connect provides dynamic situational analyses of accessibility to health services with an equity perspective and determines the optimal location of new service points to improve accessibility.

IQ-Connect integrates information from publicly available sources such as:

• Censuses with geolocation and sociodemographic characteristics of the population.
• Public digital registries of health services.
• Travel time big data obtained from publicly accessible databases from private providers.

As obtaining information on travel times from any sector of the city to another sector, on any day of the week and hour of the day can be very costly, we developed a predictive model for the solution. This predictive model, which uses machine learning techniques, estimates travel times from and to every sector of the city, for every day of the week and hour of the day.

IQ-Connect integrates the data from the travel time estimates with that of the census and of the health services, to determine accessibility. Accessibility is measured for different groups (i.e., age groups, gender, ethnicity, socioeconomic stratum, and education level) to obtain an equity perspective. 

The information is deployed on a Power BI tool that presents the findings using basic descriptive statistics and visualizations (e.g., bar graphs, dials, choropleth maps) that are accessible to diverse stakeholders and provide meaningful and simple indicators of accessibility to primary health care.[1], [4],[7]–[9] 

Using prescriptive analytics (genetic algorithms), IQ-Connect determines the optimal location of new service points to improve accessibility, again with an equity perspective. 

The platform allows end users to test scenarios and assumptions by providing filters and sliders to change travel time thresholds, traffic congestion levels, the day and time of the week, and to home in on specific sociodemographic characteristics. Variations of accessibility over time can also be assessed on the platform.[3]

IQ-Connect was developed using a person-centered design (design thinking), including inputs from people representing the three levels of governance described by Abimbola: authorities (constitutional), service users and providers (operational), as well as academics, patient advocates, watchdogs, and research groups (collective).[2]–[5] It seeks to address some of the main challenges urban and health services planners face to improve health services accessibility with equity and the needs of policymakers challenging current thinking.[3], [4], [6]

We will continue applying person-centered design to enhance the product to cover new cities, additional services, transportation means, and running serial studies to learn about travel time variations as circumstances change.[3]

The main advantages of IQ-Connect compared to existing methods used in LMICs are:

• IQ-Connect integrates, on a single platform, the information to assess accessibility. The platform reveals inequalities that are not easy to assess without integrating the information. 
• The solution is more accurate, as it is based on big data of travel times obtained from millions of measurements passively collected from smartphones, rather than on limited samples.
• Costs to evaluate accessibility are lower, as there is no need to do lengthy studies.
• Information can be easily updated when infrastructure or traffic conditions change (ex. new hospitals, new roads, road closures...).
• IQ-Connect presents indicators of accessibility in maps and graphs that provide a common language and understanding for stakeholders of different backgrounds.
• The solution is deployed in Power BI, a highly intuitive platform that allows users to interact with it without prior training. Users can easily perform data discovery exercises on the tool (for example to find patterns of accessibility for various population groups at changing traffic congestion levels).
• IQ-Connect determines the optimal location of new service points, contributing to the improvement of accessibility and not only exposing the problem.

IQuartil wants to enhance the IQ-Connect solution to automate part of the process to efficiently include new cities of LMICs and assess accessibility for other means of transportation, and health services. 

We want to assess the use and value placed by stakeholders involved in health services and land use planning and advocacy. 

REFERENCES

[1]     B. Giles-Corti et al., “What next? Expanding our view of city planning and global health, and implementing and monitoring evidence-informed policy,” Lancet Glob. Health, vol. 10, no. 6, pp. e919–e926, Jun. 2022, doi: 10.1016/S2214-109X(22)00066-3.

[2]     S. Abimbola, “Beyond positive a priori bias: reframing community engagement in LMICs,” Health Promot. Int., vol. 35, no. 3, pp. 598–609, Jun. 2020, doi: 10.1093/heapro/daz023.

[3]     L. G. Cuervo et al., “Dynamic Geographical Accessibility Assessments to Improve Health Equity: Protocol for a Test Case in Cali, Colombia [Evaluaciones Dinámicas De Accesibilidad Geográfica Para Mejorar La Equidad: Prueba En Cali, Colombia: Protocolo De Investigación].” Rochester, NY, Jul. 28, 2022. Accessed: Jul. 29, 2022. [Online]. Available: http://dx.doi.org.ezproxyberklee.flo.org/10.2139/ssrn...

[4]    C. J. M. Whitty, “What makes an academic paper useful for health policy?,” BMC Med., vol. 13, no. 1, p. 301, Dec. 2015, doi: 10.1186/s12916-015-0544-8.

[5]    S. Hendricks, N. Conrad, T. S. Douglas, and T. Mutsvangwa, “A modified stakeholder participation assessment framework for design thinking in health innovation,” Healthcare, vol. 6, no. 3, pp. 191–196, Sep. 2018, doi: 10.1016/j.hjdsi.2018.06.003.

[6]    L. G. Cuervo, E. Martínez-Herrera, D. Cuervo, and C. Jaramillo, “Improving equity using dynamic geographic accessibility data for urban health services planning,” Gac. Sanit., no. ePublication ahead of print, Jun. 2022, doi: 10.1016/j.gaceta.2022.05.001.

[7]    World Health Organization and United Nations Children’s Fund (‎‎UNICEF), “Operational Framework for Primary Health Care,” Geneva, Switzerland, Dec. 2020. Accessed: Aug. 02, 2022. [Online]. Available: https://www.who.int/publicatio...

[8]    World Health Organization and United Nations Children’s Fund (UNICEF), Primary health care measurement framework and indicators: monitoring health systems through a primary health care lens. Web annex: technical specifications. Geneva: World Health Organization, 2022. Accessed: Aug. 02, 2022. [Online]. Available: https://apps.who.int/iris/hand...

[9]    G. Boeing et al., “Using open data and open-source software to develop spatial indicators of urban design and transport features for achieving healthy and sustainable cities,” Lancet Glob. Health, vol. 10, no. 6, pp. e907–e918, Jun. 2022, doi: 10.1016/S2214-109X(22)00072-9.

IQ-Connect is a technological solution developed by engaging and keeping in mind the people and institutions that shape urban and health services planning.[1]–[6]

The target population that will ultimately benefit from this solution is that of inhabitants of big cities that currently have accessibility issues (in terms of time and costs) to health services. 

The prototype has been tested on accessibility to tertiary care emergency services, hemodialysis units, and radiotherapy services. All are primary health care services used by people facing:

• Urgent care: complex health emergencies requiring subspecialized care in which every minute counts, and it is important to reach the service with the shortest travel time for definitive treatment (i.e., requiring subspecialties, intensive care, surgery).[7]
• Frequent ambulatory care: with the scenarios of hemodialysis units and radiotherapy services used as primary health care services by people with high-cost diseases such as terminal renal failure or cancer. These services require multiple weekly sessions for prolonged times and are associated with out-of-pocket expenditure and indirect costs that can put families at financial risk and duress.[8]

By exposing the problems and inequalities in accessibility, authorities can propose and implement solutions that better serve the population of their cities.

The solution is designed for three levels of governance: constitutional (authorities), operational (service users, service providers, and service funders), and collective (community representatives, watchdogs, citizen organizations, research institutions, and academia).[3] 

Authorities do not currently count on a solution that allows them to dynamically assess accessibility, communicate using common indicators and visualizations, and assess the impact of their proposals. IQ-Connect addresses these issues. 

REFERENCES

[1] Comprender para transformar, entrevista a Oriol Nel·lo, (Jul. 22, 2018). Accessed: Aug. 17, 2020. [Online Video]. Available:

[2] C. J. Ho, H. Khalid, K. Skead, and J. Wong, “The politics of universal health coverage,” The Lancet, vol. 399, no. 10340, pp. 2066–2074, May 2022, doi: 10.1016/S0140-6736(22)00585-2.

[3] S. Abimbola, “On the meaning of global health and the role of global health journals,” Int. Health, vol. 10, no. 2, pp. 63–65, Mar. 2018, doi: 10.1093/inthealth/ihy010.

[4] K. Fiscella and P. Shin, “The Inverse Care Law: Implications for Healthcare of Vulnerable Populations,” J. Ambulatory Care Manage., vol. 28, no. 4, pp. 304–312, Dec. 2005, Accessed: Mar. 28, 2021. [Online]. Available: https://journals.lww.com/ambul...

[5] L. G. Cuervo et al., “Dynamic Geographical Accessibility Assessments to Improve Health Equity: Protocol for a Test Case in Cali, Colombia [Evaluaciones Dinámicas De Accesibilidad Geográfica Para Mejorar La Equidad: Prueba En Cali, Colombia: Protocolo De Investigación].” Rochester, NY, Jul. 28, 2022. Accessed: Jul. 29, 2022. [Online]. Available: http://dx.doi.org.ezproxyberklee.flo.org/10.2139/ssrn...

[6] Dana P. et al., “Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19:From the Emergency Cardiovascular Care Committee and Get With the Guidelines ® -Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration with the American Academy of Pediatrics, American Association for Respiratory Care, American College of Emergency Physicians, The Society of Critical Care Anesthesiologists, and American Society of Anesthesiologists: Supporting Organizations: American Association of Critical Care Nurses and National EMS Physicians,” Circulation, p. CIRCULATIONAHA.120.047463, Apr. 2020, doi: 10.1161/CIRCULATIONAHA.120.047463.

[7] L. G. Cuervo et al., “Dynamic accessibility by car to tertiary care emergency services in Cali, Colombia, in 2020: cross-sectional equity analyses using travel-time big data from a Google API.,” BMJ Open, vol. (in press), doi: http://dx.doi.org.ezproxyberklee.flo.org/10.1136/bmjopen-2022-062178.

[9] F. Piquero Villegas, Opportunities amidst uncertainty: my life with one kidney and without it. 2021.

This four-minute animation describes the project

Infographic https://figshare.com/articles/...

A team of experts in different fields participated in designing and developing the IQ-Connect solution. The team was assembled in 2020 by Dr. Luis Gabriel Cuervo as part of his doctoral thesis at Universitat Autònoma de Barcelona (Spain). Luis Gabriel is a public health professional and seasoned researcher with expertise in knowledge translation and social innovation.

IQuartil, founded in 2000, is a consulting company in analytics based in Bogota, Colombia. It developed the technical solution with inputs from stakeholders collaborating on a research project. IQuartil has the infrastructure and organization to provide training, customer service, support, and maintenance of the IQ-Connect solution. It will also provide the marketing and sales team to commercialize IQ-Connect.

Other core team members include Professor Ciro Jaramillo Ph.D., an engineer and expert in mobility and logistics at Universidad del Valle in Cali, Colombia. Ciro has provided insights into gathering information and assessing accessibility and leads the Research Group on Transport, Traffic & Roads at Universidad del Valle in Colombia.

The team also counts on Professor Eliana Martinez, Ph.D., an urban health and health equity expert. 

An extended team incorporates patient representatives, public health experts, researchers, senior advisors, and managers from the government representing planning, mobility, public health, smart cities, and the mayor’s office. These people have evaluated and given feedback on the web-based platform and are stakeholders with interest in advancing toward sustainable development goals and improving accessibility and health equity. The references list them and their contributions.

We consider that the team has the expertise to develop the solution and make IQ-Connect a viable product.

REFERENCES

Cuervo LG, Martínez-Herrera E, Cuervo D, Jaramillo C. “Improving Equity Using Dynamic Geographic Accessibility Data for Urban Health Services Planning”. Gaceta Sanitaria (E-Publication ahead of print) 11 Jun 2022. http://dx.doi.org.ezproxyberklee.flo.org/10.1016/j.gaceta.2022.05.001   

Cuervo, LG, Jaramillo C, Cuervo D, Martínez Herrera E, Hatcher-Roberts J, Pinilla LF, Bula MO, et al. “Dynamic Geographical Accessibility Assessments to Improve Health Equity: Protocol for a Test Case in Cali, Colombia.” SSRN Scholarly Paper. Rochester, NY, July 28, 2022. https://ssrn.com/abstract=4175407. http://dx.doi.org.ezproxyberklee.flo.org/10.2139/ssrn.4175407.

Cuervo, LG, Martínez-Herrera E, Osorio L, Hatcher-Roberts J, Cuervo D, Bula MO, Pinilla LF, Piquero F, and Jaramillo D. “Dynamic Accessibility by Car to Tertiary Care Emergency Services in Cali, Colombia, in 2020: Cross-Sectional Equity Analyses Using Travel-Time Big Data from a Google API.” BMJ Open (in press) (2022). http://dx.doi.org.ezproxyberklee.flo.org/10.1136/bmjopen-2022-062178.

We are applying to this SOLVE-MIT Challenge seeking financial and technical support to move from the prototype to a commercial solution. We've realized that the platform delivers valueable data, but we need to invest to improve the following aspects that will make it market-ready:

• Automate the process and therefore reduce costs of implementing other cities in the platform.
• Facilitate the process to evaluate other services.
• Include other means of transportation in the assessment.

A future investment (not in the scope of this grant) could allow us to assess accessibility by insurance providers, exploring if this data helps broker service agreements, and ultimately if it leads to practical actions that improve accessibility, health equity, and social justice.

The solution is innovative because:

• The platform allows for assessments of accessibility with an equity perspective. 
• It uses publicly available information efficiently to generate new data at an affordable cost.
• It includes machine learning models to estimate travel times at a fraction of the cost of obtaining them from the maps Apis.
• The assessments are at a fine-grained administrative level, superior to traditional inferences made from samples with average times for larger city areas.
• Optimal locations for new services can be established using prescriptive modeling (genetic algorithms). 
• We report metrics that educated laypeople normally understand and use in daily life. For example, time to the destination or the proportion of a population that can reach the service in a given travel time threshold.
• The data visualizations are easy to interpret and share among non-experts and can be used to agree on goals for intersectoral work and to measure change.
• Our platform can be expanded to cover other transport means, be used in other locations, including different services, or be adapted to integrate additional variables.
• Its development followed recommended practices for knowledge translation and uptake.[1–2] It also addressed barriers to accessibility assessment and its equity implications in urban health.[1]

REFERENCES

[1] Cuervo LG, Martínez-Herrera E, Cuervo D, Jaramillo C. “Improving Equity Using Dynamic Geographic Accessibility Data for Urban Health Services Planning”. Gaceta Sanitaria (E-Publication ahead of print) 11 Jun 2022. http://dx.doi.org.ezproxyberklee.flo.org/10.1016/j.gaceta.2022.05.001   

[2] Cuervo, LG, Jaramillo C, Cuervo D, Martínez Herrera E, Hatcher-Roberts J, Pinilla LF, Bula MO, et al. “Dynamic Geographical Accessibility Assessments to Improve Health Equity: Protocol for a Test Case in Cali, Colombia.” SSRN Scholarly Paper. Rochester, NY, July 28, 2022. https://ssrn.com/abstract=4175407. http://dx.doi.org.ezproxyberklee.flo.org/10.2139/ssrn.4175407

The impact goals for the first year are:

Implement at least three cities of Colombia or the Andean Region of Latin America (e.g., Lima in Peru and Quito in Ecuador) to understand the accessibility and equity of primary health care services of their inhabitants.

• Determine the impact of including new health service points for the selected cities.
• Provide a visual tool that promotes dialogues between city authorities in mobility, planning, and health with health service providers to improve equity in access to these services.

The impact goals for the next five years are:

• Extend the solution to other wellbeing services (ex., vaccination points, recreation, and sports centers)
• Deploy the solution for several cities in Latin America (at least 10 cities with 4 different services).

We will measure progress through the following metrics:

• Cities and population for which the IQ-Connect solution becomes available.
• Number of cities using the solution.
• Number of users accessing the platform per month.
• Number of services implemented in the solution.

IQ-Connect provides a solution to many issues that perpetuates inequality in access to health services:

• It easily and in a cost-effective way measures accesibility with an equity perspective. Current measures in many low and middle-income countries do not include this equity perspective and are costly and take a long time to be obtained. 
• It promotes collaborative discussions with an intuitive tool that allows planners, health care providers, and policymakers from different backgrounds to assess accessibility on a common set of indicators and on a common language. 

IQ-Connect's theory of change is presented in the following illustration: https://figshare.com/s/05e48c77e86dd6d04318

We use the following technologies:

• Estimated travel times for samples from applications such as Google Maps API, BING, or Waze.
• Clustering algorithms implemented in KNIME Analytics Platform (KNIME).
• Predictive modeling using KNIME and Python. We tested different machine learning and artificial intelligence techniques in the prototype, such as neural networks, random forests, XG Boost, and regressions. In the prototype, the best fitting model was random forest.
• Optimization modeling with genetic algorithms in Python.
• Visualization in Microsoft’s Power BI, a Business Intelligence tool allowing geospatial representations.

All the data is collected by IQuartil from public sources, mostly available online from government agencies. The data collected is: 

• Census data that provides information of the population and its characteristics as well as geospatial information of the inhabitants of the city.
• Traffic Analysis Zones (TAZ) of the sectors with similar traffic conditions in the city. This information is provided by the mobility secretaries of the city.
• List of health service points with the geographic location provided by the Ministry of Health.
• Travel time from the population weighed centroid of each zone to the health service points obtained from the Google Maps API.

There are two aspects of how our work incorporates diversity, equity, and inclusivity. 

First, the objective of the solution is to ensure more equitable access to health services, and in this sense, the solution already incorporates diversity and equitability as accessibility is measured for different population groups by gender, age, ethnic group, level of education, and socio-economic stratum. 

Second, at IQuartil, we have a diverse group of people in leadership roles. Of the four board members, we are three male and one female, the team is from different zones of the country, and with different genders and ethnicities. We have formed a convivence committee to address any disparity or unfairness issues. Being a small company (20 employees), the leadership of the company has direct contact with all the team constantly, and we ensure an open doors environment is maintained to listen to any concerns.

Following are the main aspects of our business model:

Value proposition:

Users of the IQ-Connect solution will be able to measure and assess accessibility to services with an equity view.

They can establish the impact of including new service points in terms of accessibility.

Planners can quickly assess the impact of changes to traffic conditions or service providers. For example, the start of operation of a new road, or the closure of an existing service point.

Impact measures:

• The main impact measure is the availability of dynamic accessibility data to essential services. The goal is that the solution will promote and enable improvements in accessibility, especially for marginalized groups. Therefore the measure is further understood by:
  • An equity perspective that considers variables such as sex, age group, ethnicity, education level, and socioeconomic stratum.
  • Changes in conditions such as the inclusion or exclusion of service points.
  • For different thresholds of what is defined as appropriate accessibility for the service. For example, in a car accident, the appropriate time to measure accessibility to a hospital might be less than 15 minutes, while for a service of radiotherapy it can be up to 20 minutes for each journey.

Market:

• Cities' planning, public health, and mobility sectors are willing to assess and improve accessibility, and define plans, programs, and policies to improve accessibility to primary health services, with equity.
• Primary health service providers that want to understand how their market is being served and determine optimal locations for new service points.
• Other service providers (ex. Vaccination, well-being centers, education sector…) that might also want to analyze accessibility and establish the optimal location of new service points.

Segments:

• Public entities related to urban planning, health, and mobility. 
• Health service providers.
• Other entities such as universities, investigative groups, and local representatives.

Channels:

• The solution is thought to be delivered as an Analytics-as-a-Service (AaaS) solution. Customers will be able to access a web portal and analyze the accessibility of the services they are interested in. They can interact with the platform and perform their own analyses.
• Customers will have a subscription to the service and be able to authenticate and use the web-based solution.

Revenue:

Revenue will come from annual subscriptions from customers to the solution, which includes service and maintenance. They will also be charged on the time they use the platform to cover infrastructure and cloud computing costs. Users of the solution will usually need other consulting services related to training and processing additional personalized requirements.

Cost structure:

• Direct costs of the product will be related to product development, information gathering, maintenance, support, customer service, and sales.
• The technological infrastructure and software licenses will be on the cloud on a pay-as-you-go (PAYG) scheme to avoid fixed costs in this aspect. As long as clients use the product they will be charged for the consumption.
• There will be some costs related to legal advice, for example, producing a contract for the lease of the product.
• Administrative and accounting will be handled by IQuartil and a fee related to income, is charged for these services.

Resources:

• The main resources for the project are:
  • Staff to develop, sell, maintain, support, and provide customer service.
  • Administrative and accounting staff.
  • Contractors for legal advice.
• Cloud-based infrastructure.
• Connectivity (normal internet connection) to gather travel times from the maps application and publicly available data.

Partner / Key stakeholders:

• The most important partners are advisors in health, mobility, and urban planning.
• The most important stakeholders are:
  • City authorities from the health, planning, mobility, and emergency response sectors. 
  • Service providers.
  • Other interested groups such as investigators, local representatives, and advocacy groups.

Financial sustainability will come from service contracts with local governments and service providers, charged an annual lease for having access to the solution. Clients will also be charged a fee for the costs associated with the PAYG services (infrastructure and licensing) every time they use the solution.

IQuartil will raise the capital required to develop the product to a commercial version from the actual prototype.

We have built a financial model that with the current assumptions provides a payback on the investment in two years and has an IRR of 25%. It assumes that the annual fee for using the solution is around US$20.000, and the licences sold per year will be:

Year 1: three licences

Year 2: three additional licences (6 in total)

Year 3: three additional licences (9 in total)

Year 4 onwards: one additional license

IQuartil has been running for 22 years as a analytics consulting company and has been sustainable even in tough times like the previous two years when business were severely affected by the pandemic. 

Cash flow from our operations and loans from local banks have allowes us to invest in this type of solutions without affecting the operation and sustainability of the company.

The risk is low that the company will lose its financially sustainability in the future because of this entrepreneurship.